2. A spinal cord injury refers to any injury to
the spinal cord that is caused by trauma
instead of disease.
3. Trauma (automobile or motor cycle
accidents, gunshot or knife wounds, falls
and sports mishaps)
Vertebrae most commonly involved are the
5th, 6th and 7th cervical vertebrae, 12th
thoracic vertebrae and 1st lumbar vertebrae
4. Mechanism of injury
Level of injury
Degree of injury
6. Occurs when the head strikes the
steering wheel, the spine is forced
into acute hyper flexion
Rupture of posterior ligaments results in
forward dislocation of the vertebrae
Cervical spine usually affected are the C5 to
C6 level
7. Results after a fall in
which the chin hits an
object and the head
is thrown back
Anterior ligament is ruptured with fracture
of the posterior elements of the vertebral
body
Greatest area of stress is at the C4 and C5
8. Caused by falls or jumps
in which the person lands
directly on the head,
sacrum or feet
Force of impact fractures
the vertebrae and the
fragments compress the
cord
Lumbar and lower
thoracic vertebrae are
usually affected
10. Complete cord injury
- Results in total loss of sensory and motor
function below the level of injury
Incomplete cord injury
- mixed loss of voluntary motor activity and
sensation and leaves some tracts intact
11. Central cord syndrome
Anterior cord syndrome
Brown sequard syndrome
Posterior cord syndrome
Conus medullaris and cauda equina syndrome
12. Damage to central
spinal cord
Occurs most commonly
in the cervical region
Motor weakness and
sensory loss are present
in both upper and lower
extremities
13. Caused by damage to
anterior spinal artery
Results from injury causing
compression of anterior
portion of the spinal
cord(flexion injury)
Paralysis and loss of pain
and temperature sensation
below the level of injury
Sensation of touch, position
and vibration remains intact
14. Result of damage to
one half of the spinal
cord(knife or missile
injury)
Ipsilateral paralysis
with ipsilateral loss of
touch and pressure
and contralateral loss
of pain and
temperature
15. Results from damage to the posterior spinal
artery
Dorsal columns are damaged resulting in loss
of proprioception
Pain, temperature and motor function below
the level of lesion remains intact
16. Result from damage to the
very lowest portion of the
spinal cord (conus) and the
lumbar and sacral nerve
roots(cauda equina)
Flaccid paralysis of the
lower limbs and
areflexia(flaccid bladder and
bowel)
17. Respiratory system
Injury below the level of C4
diaphragmatic breathing hypoventilation
Cervical and thoracic injuries paralysis of
abdominal and intercostal muscles
patient cannot cough effectively to remove
secretions atelectasis and pneumonia
Neurogenic pulmonary edema
18. Cardio vascular system
Injury above the level of T6 decreases the
influence of sympathetic nervous system
bradycardia occurs
peripheral vasodilation
reduces return of blood to the heart
Decreases cardiac output hypotension
20. Gastrointestinal system
Injury above the level of T5 decreased
gastro intestinal motility development of
paralytic ileus and gastric distension
Development of stress ulcers
Intra abdominal bleeding
Less voluntary control over the bowel
neurogenic bowel(bowel is arereflexic and
sphincter tone is decreased)
21. Problems with thermoregulation
Poikilothermism is lost in spinal cord injuries
Decreased ability to sweat or shiver below
the level of the lesion
Patients with high cervical injury have a
greater loss of ability to regulate
temperature
23. Spinal shock and neurogenic shock
Spinal shock
- Temporary loss of neurologic function
characterized by decreased reflexes, loss of
sensation and flaccid paralysis below the
level of injury
- syndrome lasts days to months
24. Neurogenic shock
- Effects are associated with cervical or
high thoracic injury
- Due to loss of vasomotor tone caused by
injury and is characterized by hypotension
and bradycardia
- peripheral vasodilation decreased
cardiac output
25. History and physical examination
X ray spine
CT scan
MRI scan
Vertebral angiography
27. Neurogenic bladder
- Include urgency, frequency,
incontinence, inability to void and high
bladder pressure resulting in reflux of urine
into the kidneys
Neurogenic bowel
- Voluntary control of bowel evacuation
is lost
28. -Hypertension
- Throbbing headache
- Marked diaphoresis above the level of
the lesion
- Bradycardia
- flushing of the skin above the level of
the lesion
- pale extremities below the level of the
lesion
29. Loss of circulatory control
Muscle tone problems
- Spastic and flaccid muscles
30. Initial care
Neck should be stabilized in a
neutral position without flexion or
extension
Place the affected person on a
spine board and secure the spine
with a hard collar around the neck
31. Log rolling
technique
Maintain a patent
airway
Mechanically
assisted ventilation
patients with
severe cervical
injury, placed in
skeletal traction
32. Drug therapy
Methyl prednisolone(effective if given within
8 hours of injury)
Loading dose of 30mg|kg given within 3
hours of injury followed by 24 hours of
5.4mg|kg IV methyl prednisolone drip
Vasopressor agents (dopamine)
Histamine 2 receptor blocking agents
33. Managing respiratory dysfunction
If the injury is at or above C3 endotracheal
intubation and mechanical ventilation
Chest physiotherapy, adequate oxygenation and
pain management
Use of incentive spirometry
34. Managing cardiovascular instability
In case of bradycardia, administer
anticholinergic(atropine)
Hypotension managed with dopamine infusion
Compression gradient stockings to prevent DVT
If severe blood loss has occurred, blood should
be administered according to protocol
35. Fluid and nutritional balance
First 48 to 72 hours after SCI GI tract may stop
functioning (paralytic ileus)
NG tube insertion for gastric decompression
Introduce oral foods and fluids once the bowel
sounds returns
In patients with high cervical injuries swallowing
capacity must be evaluated
Increased dietary fiber
36. Temperature control
Monitor body temperature
Monitor the environment closely to maintain
appropriate temperature
Patient should not be overloaded with covers
or unduly exposed
37. Managing stress ulcers
Stool and gastric contents are tested daily
for blood
Give corticosteroids along with antacids
H2 receptor blockers or proton pump
inhibitors
38. Bladder and bowel management
Insertion of indwelling catheter
After patient is stabilized, start intermittent
catheterization
Suppository should be inserted daily
Increased fiber intake
39. Ineffective breathing pattern related to
weakness or paralysis of abdominal and
intercostal muscles
Impaired physical mobility related to motor
and sensory impairments
Disturbed sensory perception related to
motor and sensory impairment
Impaired urinary elimination related to
inability to void spontaneously
Constipation related to presence of atonic
bowel
40. Risk for impaired skin integrity related to
immobility
Risk for autonomic dysreflexia related to
reflex stimulation of sympathetic nervous
system after spinal shock resolves